Diagnostic performance of serum exosomal miRNA-720 in hepatocellular carcinoma

Background@#/Aim: Hepatocellular carcinoma (HCC) is associated with poor prognosis, largely due to late detection. Highly accurate biomarkers are urgently needed to detect early-stage HCC. Our study aims to explore the diagnostic performance of serum exosomal microRNA (miR)-720 in HCC. @*Methods@#Exosomal miRNA was measured via quantitative real-time PCR. A correlation analysis of exosomal miR-720 and tumor or clinico-demographic data of patients with HCC was performed. The receiver operating characteristic (ROC) curve was used to assess the diagnostic capacity of serum exosomal miR-720 for HCC, in comparison with α-fetoprotein (AFP) and prothrombin induced by vitamin K absence or antagonist-II (PIVKA-II). @*Results@#MiR-720 was chosen as a potential HCC marker via miR microarray based on significant differential expression between tumor and non-tumor samples. Serum exosomal miR-720 was significantly upregulated in patients with HCC (n=114) versus other liver diseases (control, n=30), with a higher area under the ROC curve (AUC=0.931) than the other markers. Particularly, serum exosomal miR-720 showed superior performance in diagnosing small HCC (< 5 cm; AUC=0.930) compared with AFP (AUC=0.802) or PIVKA-II (AUC=0.718). Exosomal miR-720 levels showed marginal correlation with tumor size. The proportion of elevated miR-720 also increased with intrahepatic tumor stage progression. Unlike AFP or PIVKA-II showing a significant correlation with aminotransferase levels, the exosomal miR-720 level was not affected by aminotransferase levels. @*Conclusions@#Serum exosomal miR-720 is an excellent biomarker for the diagnosis of HCC, with better performance than AFP or PIVKA-II. Its diagnostic utility is maintained even in small HCC and is unaffected by aminotransferase levels.

Successful Sequential Therapy Involving Regorafenib after Failure of Sorafenib in a Patient with Recurrent Hepatocellular Carcinoma after Liver Transplantation

The efficacy and safety of sequential systemic therapy for the treatment of recurrent hepatocellular carcinoma (HCC) after liver transplantation (LT) are not well established. This study describes a successful experience where sequential therapy with sorafenib followed by regorafenib was used to treat recurrent HCC in a 54-year old male LT recipient. After HCC recurred in both lungs 10 months after LT, sorafenib was administered with radiation therapy to treat pulmonary metastases. However, after 4 months of sorafenib treatment showed progressive pulmonary metastases, sequential regorafenib treatment was started. After 3 months (cycles) of regorafenib treatment, tumor response was partial, and after 6 months (cycles), disease status remained stable without signs of progression or drug-related serious adverse events. This case suggests that sequential systemic therapy is feasible in patient with recurrent HCC after LT.

Cardiac diastolic dysfunction predicts poor prognosis in patients with decompensated liver cirrhosis

BACKGROUND/AIMS: Left ventricular diastolic dysfunction (LVDD) is an early manifestation of cardiac dysfunction in patients with liver cirrhosis (LC). However, the effect of LVDD on survival has not been clarified, especially in decompensated LC. METHODS: We prospectively enrolled 70 patients with decompensated LC, including ascites or variceal bleeding, at Daejeon St. Mary's Hospital from April 2013 to April 2015. The cardiac function of these patients was evaluated using 2D echocardiography with tissue Doppler imaging. The diagnosis of LVDD was based on the American Society of Echocardiography guidelines. The primary endpoint was overall survival. RESULTS: Forty-four patients (62.9%) had LVDD. During follow-up (22.3 months), 18 patients died (16 with LVDD and 2 without LVDD). The survival rate was significantly lower in patients with LVDD than in those without LVDD (31.1 months vs. 42.6 months, P=0.01). In a multivariate analysis, the Child-Pugh score and LVDD were independent predictors of survival. Moreover, patients with a ratio of early filling velocity to early diastolic mitral annular velocity (E/e') ≥ 10 (LVDD grade 2) had lower survival than patients with E/e' ratio < 10. CONCLUSIONS: The presence of LVDD is associated with poor survival in patients with decompensated LC. Therefore, it may be important to monitor and closely follow LVDD patients.

A comparative study of sorafenib and metronomic chemotherapy for Barcelona Clinic Liver Cancer-stage C hepatocellular carcinoma with poor liver function

BACKGROUND/AIMS: Metronomic chemotherapy (MET) is frequently administered in comparatively low doses as a continuous chemotherapeutic agent. The aim of this study was to evaluate the feasibility and overall survival (OS) of MET compared to sorafenib for advanced hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT). METHODS: A total of 54 patients with advanced HCC and PVTT who had undergone MET were analyzed between 2005 and 2013. A total of 53 patients who had undergone sorafenib therapy were analyzed as the control group. The primary endpoint of this study was OS. RESULTS: The median number of MET cycles was two (1-15). The OS values for the MET group and sorafenib group were 158 days (132-184) and 117 days (92-142), respectively (P=0.029). The Cox proportional-hazard model showed that a higher risk of death was correlated with higher serum alpha fetoprotein level (≥400 mg/dL, hazard ratio [HR]=1.680, P=0.014) and Child-Pugh class B (HR=1.856, P=0.008). CONCLUSIONS: MET was associated with more favorable outcomes in terms of overall survival than was sorafenib in patients with advanced HCC with PVTT, especially in patients with poor liver function. Therefore, MET can be considered as a treatment option in patients with advanced HCC with PVTT and poor liver function.

STX0119 Ameliorates Arthritis in SKG Mice via Inhibiting T Helper 17

Rheumatoid arthritis (RA) is an autoimmune disease with chronic and excessive inflammation. Upregulation of interleukin (IL)-17 is involved in the pathogenesis of RA. STX0119 is a specific inhibitor of signal transducer and activator of transcription 3 (STAT3) as a potential target for the treatment of RA. STAT3 is a member of DNA-binding molecules that regulates the expression of proinflammatory cytokines involved in the pathogenesis of RA. The objective of this study was to determine whether STX0119 could inhibit STAT3 and IL-17. We demonstrated that STX0119 decreased T helper (Th) 17 differentiation and IL-17 expression in vitro. STX0119 also improved the severity of zymosan induced arthritis and reduced joint inflammation. STX0119 reduced the proliferation of Th17 and phosphorylated STAT3 expression while increasing Treg differentiation and phosphorylated STAT5 expression. Moreover, STX0119 decreased the expression of IL-6 and -17 but not IL-10. These findings suggest that STX0119 can be used to treat autoimmune RA through inhibiting the activation of STAT3.

Perception of sugar reduction, nutrition education, and frequency of snacking in children by the self-perceived sweet dietary habits of mothers in Busan

BACKGROUND/OBJECTIVES: The aim of this study was to investigate the perception of sugar reduction, nutrition education, and frequency of snacking in children according to the self-perceived dietary preferences for sweet taste by mothers in Busan. SUBJECTS/METHODS: A total of 277 mothers were surveyed, and their perceptions of sugar reduction and the frequency of snacking in children were assessed using a questionnaire. The subjects were classified into either a sweet (n = 91) or an unsweet (n = 186) group according to their self-perceived preferences for a sweet taste. RESULTS: In the sweet group, the results for sweet products were sweetened ice (86.8%), confectionery (74.7%), processed milk (73.6%), carbonated beverages (71.4%), and fermented milk (53.9%). In the unsweet group, the results were sweetened ice (88.7%), carbonated beverages (78.5%), processed milk (75.8%), confectionery (69.4%), and fermented milk (50.5%). The necessity of sugar intake reduction was high in both groups (sweet = 89.0%, unsweet = 82.8%). Beverage purchases after identifying the nutrition labeling was significantly lower in the sweet group than in the unsweet group (P < 0.05). The reasons for the beverage purchases instead of water were "habitually" (50.5%) and "like sweet taste" (25.3%) in the sweet group (P < 0.01). Snacking in children was significantly higher in the sweet group based on the increased frequencies of carbonated drinks (P < 0.01), fast food (P < 0.001), candy and chocolate (P < 0.05), crackers (P < 0.01), ramen (P < 0.01), and fish paste/hotdogs (P < 0.01). The frequency of purchase education after identifying the nutrition labeling was significantly lower in the sweet group than in the unsweet group (P < 0.01). CONCLUSIONS: These findings suggest that a perception of sugar reduction and practical nutrition education aimed at reducing the sugar intake are necessary to improve dietary habits.

Emphysematous pyelonephritis initially presenting as a spontaneous subcapsular hematoma in a diabetic patient

Emphysematous pyelonephritis (EPN) is a life-threatening infection characterized by the formation of gas. Complications of EPN include septic shock, acute renal failure, and disseminated intravascular coagulation. Spontaneous subcapsular hematoma (SCH) has also been reported as a rare complication of EPN, although there have been no reports to date of this occurring prior to the presentation of EPN. We report a case of EPN that initially presented as spontaneous SCH. The patient was admitted for left flank pain, and initial computed tomography revealed SCH without any air shadows. Laboratory findings and clinical symptoms suggested the presence of urinary tract infection and the patient was started on antibiotics. Fever developed 24 hours after admission. On follow-up computed tomography 7 days later, EPN was newly observed, and a percutaneous drain was inserted. Blood, urine, and drainage fluid cultures all revealed growth of extended-spectrum beta-lactamase-negative Escherichia coli.

Dietary total sugar intake of Koreans: Based on the Korea National Health and Nutrition Examination Survey (KNHANES), 2008-2011 / 한국영양학회지

PURPOSE: The aim of this study is to estimate total sugar intake and identify major food sources of total sugar intake in the diet of the Korean population. METHODS: Dietary intake data of 33,745 subjects aged one year and over from the KNHANES 2008-2011 were used in the analysis. Information on dietary intake was obtained by one day 24-hour recall method in KNHANES. A database for total sugar content of foods reported in the KNHANES was established using Release 25 of the U.S. Department of Agriculture National Nutrient Database for Standard Reference, a total sugar database from the Ministry of Food and Drug Safety, and information from nutrition labeling of processed foods. With this database, total sugar intake of each subject was estimated from dietary intake data using SAS. RESULTS: Mean total sugar intake of Koreans was 61.4 g/person/day, corresponding to 12.8% of total daily energy intake. More than half of this amount (35.0 g/day, 7.1% of daily energy intake) was from processed foods. The top five processed food sources of total sugar intake for Koreans were granulated sugar, carbonated beverages, coffee, breads, and fruit and vegetable drinks. Compared to other age groups, total sugar intake of adolescents and young adults was much higher (12 to 18 yrs, 69.6 g/day and 19 to 29 yrs, 68.4 g/day) with higher beverage intake that beverage-driven sugar amounted up to 25% of total sugar intake. CONCLUSION: This study revealed that more elaborated and customized measures are needed for control of sugar intake of different subpopulation groups, even though current total sugar intake of Koreans was within the range (10-20% of daily energy intake) recommended by Dietary Reference Intakes for Koreans. In addition, development of a more reliable database on total sugar and added sugar content of foods commonly consumed by Koreans is warranted.

The use Frequency and Amount of Food Sources of Sodium and Knowledge Requirement, and Job Satisfaction of Dietitians and Nutrition Teachers according to the School Types in Busan / 대한지역사회영양학회지

OBJECTIVES: To investigate the use frequency and amount of food sources of sodium and knowledge requirement, and job satisfaction with school food services according to the school types in Busan. METHODS: A total of 98 schools were surveyed and knowledge requirement and job satisfaction were assessed using a questionnaire. In addition, the use frequency and amount of food sources of sodium for 10 school days were examined. RESULTS: The response rate of the most difficult area among dietitians' tasks was significantly high in 'nutrition education and counseling' for elementary schools and 'hygiene management' for high schools (p < .05). The response rate of the factors to be considered in meal planning was significantly high in 'energy and nutrients requirement' for elementary schools and 'menu/taste preference of students' for middle and high schools (p < .05). The response rate of whether school food services affect health and eating habits of students or not was significant high in 'very helpful' for elementary schools (p < .001). The average sodium contents in the meals of elementary, middle and high schools was 1981.4 mg/meal/person/day, 1867.3 mg/meal/person/day and 1,329.9 mg/meal/person/day, respectively. For foods in highest sodium, Kimchi, Oribulgogi, and Kare rice were ranked 1st, 2nd and 3rd respectively. The main reason for not providing the fruits was 'price' among all groups. The knowledge requirement such as 'nutrition and menu management', 'nutrition education', and 'nutrition counseling' was significantly higher in elementary school compared with middle and high school (p < .001, p < .01, and p < .01 respectively). The dietitians and nutrition teachers of elementary schools have a higher job satisfaction compared with those of middle schools (p < .01). The job satisfaction was positively correlated with knowledge requirement of dietitians and nutrition teachers of elementary and middle schools. CONCLUSIONS: The results suggest that developing dietitians' education program about knowledge requirement contribute to increasing the school food service and job satisfaction in elementary and middle schools.

Two Cases of Refractory Pseudomembranous Colitis that Healed Following Fecal Microbiota Transplantation / 대한내과학회지

The incidence, recurrence, and mortality of Clostridium difficile infection are increasing and the standard therapy is oral metronidazole or vancomycin. Since treatment failure with standard therapy is increasing, an alternative therapy is needed. Fecal microbiota transplantation is one effective method in patients with refractory or recurrent C. difficile infection, including pseudomembranous colitis. Here, we report two cases of refractory pseudomembranous colitis treated with fecal microbiota transplantation.

The total sugar and free sugar content in beverages categorized according to recipes at coffee and beverage stores / 한국영양학회지

This study was designed to investigate the amount of free sugar according to each beverage category in coffee and beverage stores. The groups were categorized as 15 groups based on the kind of beverage material. The beverage groups contributing to total sugar per 100 mL were milk + syrup or powder, hot (12.9 g), ade (12.6 g), milk + syrup or powder + crushed ice (11.9 g), and espresso shot + milk + syrup + crushed ice (11.4 g). The beverage groups contributing to free sugar per 100 mL were ade (12.6 g), milk + syrup or powder + crushed ice (10.8 g), espresso shot + milk + syrup + crushed ice (10.3 g), and milk + syrup or powder, hot (9.7 g). The beverage groups contributing to total sugar (energy) per portion size were milk + syrup or powder + crushed ice 56.6 g (332.3 kcal), espresso shot + milk + syrup + crushed ice 49.3 g (333.4 kcal), milk + syrup or powder, hot 46.3 g (372.1 kcal), and milk + syrup or powder, ice 38.1 g (325.9 kcal). The beverage groups contributing to free sugar per portion size were milk + syrup or powder + crushed ice 51.2 g, espresso shot + milk + syrup + crushed ice 44.9 g, ade 37.1 g, milk + syrup or powder, hot 34.6 g, and milk + syrup or powder, ice 30.1 g. The percent of average free sugar per portion size of the WHO recommendation (free sugars <10% of total energy; <50 g/2,000 kcal) was milk + syrup or powder + crushed ice 102.4%, espresso shot + milk + syrup + crushed ice 89.8%, ade 74.1%, and milk + syrup or powder, hot 69.2%. The proportion of beverage in excess of WHO recommendation per portion size was 14.6% in espresso shot + milk + syrup + crushed ice, 22.7% in ade, and 10.9% in milk + syrup or powder, hot. Therefore, in coffee and beverage stores, menu development with reduced sugar content is needed, and nutrition information should be provided through sugar nutrition labeling.

A Study on Dietary Habits, Body Satisfaction and Nutritional Knowledge by Body Image of Middle School Girl Students in Chungbuk Area / 대한지역사회영양학회지

This study was performed to investigate the dietary habits, body satisfaction and nutritional knowledge according to body image of middle school girl students (n = 284). The subjects were classified as lean, normal and fat groups according to body image. The weight, body mass index (BMI) and the score of body image were significantly higher in the students who recognized their body image as 'fat'. The satisfaction of present body image was significantly lower in students who recognized their body image as 'lean'. The interest in weight control and experience of weight control were significantly higher in students who recognized their body image as 'fat'. The necessity of nutrition education was higher in all groups (lean 67.2%, normal 59.0% and fat 52.8%). The products used to feel sweetened were sweetened ice (68.7%), processed milk (68.3%), confectionery (62.3%), carbonated beverage (55.3%), fermented milk (38.0%) and none (6.0%). The frequency of consumption of fruit juices and fried food was significantly higher in 'normal' compared to 'fat'. There was no significant difference in the frequency of consumption of snack and nutritional knowledge among the three groups. In the multiple regression analysis, the score of body image was negatively associated with the frequency of snack consumption in the 'lean'. The score of body image was positively associated with identification of nutrition labels and an interest in weight control but was negatively associated with satisfaction of present body image in the 'fat'. Based on these results, we conclude that, the middle school girl students need correct recognition of body image and continuous and practical nutrition education in order to maintain healthy dietary habits.

Successful Surgery for Scoliosis Supported by Pulmonary Rehabilitation in a Duchenne Muscular Dystrophy Patient With Forced Vital Capacity Below 10%

Low vital capacity is a risk factor for scoliosis correction operation in Duchenne muscular dystrophy (DMD) patients, but pulmonary rehabilitation, including noninvasive intermittent positive pressure ventilator application, air stacking exercise, and assisted coughing technique, reduces the pulmonary complications and perioperative mortality risk. In this case, the patient's preoperative forced vital capacity (FVC) was 8.6% of normal predicted value in sitting position and 9.4% in supine position. He started pulmonary rehabilitation before the operation and continued right after the operation. Scoliosis correction operation was successful without any pulmonary complications, and his discomfort in sitting position was improved. If pulmonary rehabilitative support is provided properly, FVC below 10% of normal predicted value is not a contraindication of scoliosis correction operation in DMD patients.

Production and evaluation of children's dietary life safety index data on metropolitan cities and provinces in Korea

This pilot study was performed to produce data of the Children's Dietary Life Safety (CDLS) Index which is required by the Special Act on Safety Management of Children's Dietary Life and to evaluate the CDLS Index for 7 metropolitan cities and 9 provinces in Korea. To calculate the CDLS Index score, data regarding the evaluation indicators in the children's food safety domain and children's nutrition safety domain were collected from the local governments in 2009. For data regarding the indicators in the children's perception & practice domain, a survey was conducted on 2,400 5th grade children selected by stratified sampling in 16 local areas. Relative scores of indicators in each domain were calculated using the data provided by local governments and the survey, the weights are applied on relative scores, and then the CDLS Index scores of local governments were produced by adding scores of the 3 domains. The national average scores of the food safety domain, the nutrition safety domain and the perception and practice domain were 23.74 (14.67-26.50 on a 40-point scale), 16.65 (12.25-19.60 on a 40-point scale), and 14.88 (14.16-15.30 on a 20-point scale), respectively. The national average score of the CDLS Index which was produced by adding the scores of the three domains was 55.27 ranging 46.44-58.94 among local governments. The CDLS Index scores produced in this study may provide the motivation for comparing relative accomplishment and for actively achieving the goals through establishment of the target value by local governments. Also, it can be used as useful data for the establishment and improvement of children's dietary life safety policy at the national level.

Meal skipping relates to food choice, understanding of nutrition labeling, and prevalence of obesity in Korean fifth grade children

This study was performed to investigate the differences in food choice, nutrition labeling perceptions, and prevalence of obesity due to meal skipping in Korean elementary school children. A national survey was performed in 2010 to collect data on food intake frequency, understanding of nutrition labeling, and body mass index from 2,335 fifth grade students in 118 elementary schools selected from 16 metropolitan local governments by stratified cluster sampling. The data were analyzed using the SAS 9.1 and SUDAAN 10.0 packages. Students who consumed three meals for 6-7 days during the past week were classified into the regular meal eating (RM) group (n = 1,476) and those who did not were placed into the meal skipping (MS) group (n = 859). The daily intake frequency of fruits, vegetables, kimchi, and milk was significantly lower in the MS group compared to that in the RM group (P < 0.001), whereas the daily intake frequency of soft drinks and instant noodles (ramyeon) was significantly higher in the MS group than that in the RM group (P < 0.05). The MS group demonstrated a significantly lower degree of understanding with regard to nutrition labeling and high calorie foods containing low nutritional value than that in the RM group. The distribution of obesity based on the percentile criteria using the Korean growth chart was different between the MS and RM groups. The MS group (8.97%) had a higher percentage of obese subjects than that in the RM group (5.38%). In conclusion, meal skipping was related to poor food choice, low perception of nutrition labeling, and a high prevalence of obesity in Korean fifth grade children.

The Significance of Transcutaneous Continuous Overnight CO2 Monitoring in Determining Initial Mechanical Ventilator Application for Patients with Neuromuscular Disease

OBJECTIVE: To reveal the significance of continuous transcutaneous carbon dioxide (CO2) level monitoring through reviewing cases which showed a discrepancy in CO2 levels between arterial blood gas analysis (ABGA) and continuous transcutaneous blood gas monitoring. METHOD: Medical record review was conducted retrospectively of patients with neuromuscular diseases who had started home mechanical ventilation between June 2008 and May 2010. The 89 patients underwent ABGA at the 1st hospital day, and changes to their CO2 level were continuously monitored overnight with a transcutaneous blood gas analysis device. The number of patients who initially appeared to show normal PaCO2 through ABGA, yet displayed hypercapnea through overnight continuous monitoring, was counted. RESULTS: 36 patients (40.45%) presented inconsistent CO2 level results between ABGA and continuous overnight monitoring. The mean CO2 level of the 36 patients using ABGA was 37.23+/-5.11 mmHg. However, the maximum and mean CO2 levels from the continuous monitoring device were 52.25+/-6.87 mmHg and 46.16+/-6.08 mmHg, respectively. From the total monitoring period (357.28+/-150.12 minutes), CO2 retention over 45 mmHg was detected in 198.97 minutes (55.69%). CONCLUSION: Although ABGA only reflects ventilatory status at the puncturing moment, ABGA results are commonly used to monitor ventilatory status in most clinical settings. In order to decide the starting point of home mechanical ventilation in neuromuscular patients, continuous overnight monitoring should be considered to assess latent CO2 retention.

Noninvasive Ventilatory Support in a Patient with Bilateral Phrenic Nerve Palsy: A Case Report

Bilateral phrenic nerve palsy after open cardiac surgery is an extremely rare complication, but serious enough to induce respiratory failure or cardiac arrest. We report a 76-year-old male patient presented weaning difficulty after elective aortic valve replacement and thymic resection under hypothermic cardiopulmonary bypass. Bilateral phrenic nerve palsy was diagnosed through chest radiograph and electrophysiological studies of the diaphragm. After receiving tracheostomy, invasive intermittent positive-pressure ventilation (IPPV) was applied to him at intensive care unit. He was referred to our hospital because of weaning difficulty which lasted for 6 months after the surgery. He received extensive pulmonary rehabilitation which includes non-invasive positive-pressure ventilation (NIPPV), and then he finally succeeded in weaning from ventilator after 8 months. Applying NIPPV to patients with bilateral phrenic nerve palsy could minimize the duration of IPPV, reduce its disadvantages, and facilitate weaning of artificial ventilation.

Development of Evaluation Indicators for a Children's Dietary Life Safety Index in Korea

This study was performed to develop a children's dietary life safety index required by the Special Act on Safety Management of Children's Dietary Life enacted in 2009. An analytical hierarchy process was used to obtain initial weights of dietary life safety evaluation indicators. The Delphi method was applied to develop the weights along with 98 food and nutrition professionals. Three representative policy indicators, nine strategy indicators, 11 main evaluation indicators, and 20 detailed evaluation indicators were selected for the children's dietary life safety assessment. Three policy indicators and nine strategy indicators were the following: children's food safety indicator (support level of children' safety, safety management level of children's favorite foods, and safety management level of institutional food service), children's nutrition safety indicator (management level of missing meals and obesity, nutrition management level of children's favorite foods, and nutrition management level of institutional food service), and children's perception and practice level indicator ("Dietary Life Law" perception level, perception, and practice level for dietary life safety management, perception, and practice level for nutrition management). Weights of 40%, 40%, and 20% were given for the three representative policy indicators. The relative importance of nine strategic indicators, which were determined by the Delphi method is as follows: For children's food safety, support level of children's safety, safety management level of children's favorite foods, and safety management level of institutional food service were given weights of 12%, 9%, and 19%, respectively. For children's nutrition safety, the missing meals and obesity management level, nutrition management level of children's favorite foods, and the nutrition management level of institutional food service were given weights of 13%, 11%, and 16%, respectively. The "Dietary Life Law" perception level, perception and practice level of dietary life safety management, and perception and practice level of nutrition management were given weights of 4%, 7%, and 9%, respectively.

Comparison of Perception and Practice Levels of Dietary Life in Elementary School Children according to Gender and Obesity Status

This study was performed to analyze children's perceptions and practice levels according to gender and obesity status using a dietary life safety index. A national survey was conducted on fifth grade children (n = 2,400), who were selected using three-stage stratified cluster sampling from 16 provinces. The average height was 144.8 cm, and weight was 38.8 kg. The average body mass index was 18.4 kg/m2 and underweight, overweight, and obese children were identified using the 2009 KHNANES cutoff values, which were 5.3%, 10%, and 5.9%, respectively. The perception and practice scores for hand-washing prior to eating were high and the score for willing to buy at a clean store was also high. However, students answered that the hygiene level of food stores near the school was poor. More students skipped breakfast than lunch or dinner. The frequency scores for fruit and vegetables were significantly higher for girls than those for boys. Students had a good understanding of nutrition labeling but did not frequently check the label. Seventy-five percent of the students tried to avoid high calorie foods with low nutritional value, but only 40% had the appropriate knowledge about high calorie foods with low nutritional value. Girls had better dietary life perception and practice levels than those of boys. No differences in perception or practice levels were observed based on obesity status. Nutrition education on the importance of eating breakfast and having accurate knowledge on nutrition labeling and high calorie foods with low nutritional value is needed. Behavior-centered education should be implemented to improve the perceptions and practice level of student's dietary life.

Pneumothorax Associated with Noninvasive Intermittent Positive Pressure Ventilation in Duchenne Muscular Dystrophy: A case report

Duchenne muscular dystrophy (DMD) is a severe X-linked recessive disorder characterized by rapid progression of muscle wasting and weakness. Long term noninvasive intermittent positive pressure ventilation (NIPPV) is an important treatment for neuromuscular patients with chronic respiratory failure. NIPPV is easy to administer and life-threatening complications are rare. We report two cases of pneumothorax associated with long term NIPPV in DMD. Given the increasing utilization of chronic NIPPV, we suggest that caregivers and patients must be aware of this potentially life-threatening complication.